The following lists palliative care research primarily conducted by Australian research groups. The list is based on application of the CareSearch search filter for palliative care to identify articles held within the PubMed database and corresponding to the strongest evidence. Articles have been selected based on relevance and new articles are added on a weekly basis.
Whilst not an exhaustive list, the aim is to keep the community informed by providing a snapshot of recent research findings and planned studies in the Australian setting.
Button E, Virdun C, Mudge A, Donovan T, Singh GK, Yates P, et al.
Background: Acute inpatient care does not always align with the known palliative care needs and preferences of people with deteriorating health. The LEAHP (Listen, Empower and Act to improve Hospital Palliative care) bundle is a novel intervention combining collection and feedback of patient reported experience measures (PREMs), an understanding of context, co-design of a shared vision and facilitated clinician-led improvements in quality of care, for inpatients with palliative care needs. We describe the resource requirements for pilot implementation of the LEAHP bundle, and potential cost considerations for sustaining and spreading this initiative.
Methods: A prospective costing analysis was conducted alongside a pre-post implementation study between May 2022 and Nov 2023 across three wards in a large hospital in Australia. A health service perspective was taken, with costs collected during the study period and valued in 2023 Australian dollars. Costs included Project Team and Clinical Team labour, as well as non-labour resources. Time-driven, activity-based costing methods were adopted, with implementation activities categorised using a modified Expert Recommendations for Implementing Change (ERIC) Framework headings. A scenario analysis explored cost reductions that would support sustaining and spreading of the initiative.
Results: The total average cost of implementing the LEAHP bundle for each ward over approximately 12 months was $37,019; consisting of $26,289 (71%) Project Team, $8,870 (24%) Clinical Team, and $2,053 (5%) non-labour average costs. The greatest percentage of costs was attributed to the Facilitator (average $13,488 per ward, 36% overall) and the Research Nurse (average of $10,868 per ward, 29%). In a scenario analysis testing sustainment and spread, the total average cost of implementing the LEAHP bundle was an average of $25,251 per ward ($15,212 [60%] Project Team, $8,373 [33%] Clinical Team, and $1,667 [7%] non-labour costs) – 32% less than the base case.
Conclusions: Pilot implementation of the LEAHP bundle required investment from both the Project Team and Clinical Team to enable facilitation, collection of PREMs, an understanding of context, and engagement of clinicians to implement improvements for inpatients with palliative care needs. Sustainment would be contingent on the resources required for facilitation in a changing clinical context and on mechanisms for collecting and processing the PREM data. Future research is warranted to explore sustainable and widescale implementation of this promising intervention.
Rasekaba TM, Hodge O, Blackberry I, Rich S, Webb N, Steer CB.
Introduction: Healthcare is increasingly shifting from a paternalistic model to one that prioritises person-centred care (PCC). Despite this trend, implementing PCC in the care of older adults diagnosed with cancer remains challenging. The Age-Friendly Health Systems (AFHS) initiative provides a structured framework - the 4Ms (What Matters, Medication, Mentation, and Mobility) - to promote consistent, evidence-based care for older adults. It has demonstrated benefits in general geriatric care; however, applying the 4Ms principles in oncology is underexplored. This study aimed to assess the feasibility of enhancing geriatric assessment (GA) by integrating two novel person-centred elements: Photovoice (two patient-supplied photographs inspired by "Photovoice" principles but not constituting a full Photovoice methodology) and the "This is Me" (TiM) tool.
Materials and methods: A cross-sectional mixed-methods study evaluated the feasibility of integrating two novel elements (two patient-supplied photographs and the TiM tool) into GA, with the aim of promoting practice based on the AFHS 4Ms framework principles. Twenty consecutive patients (≥70 years, G8 score ≤ 14) from a regional cancer centre completed the assessment (electronic Rapid Fitness Assessment [eRFA]-Photo-TiM, as well as the Mini-Cog and Timed-Up-and-Go). Results were presented at a weekly "enhanced supportive care" (ESC) multidisciplinary team (MDT) meeting. Participants completed post-assessment surveys and interviews.
Results: All patients (n = 20), aged 79 years, 45% female, completed the eRFA, 19 completed the TiM, and 18 provided photographs. The combined assessment was overall acceptable and feasible, user-friendly, captured patients' values and contexts, and facilitated supportive care referrals and advance care planning discussions. ESC-MDT members valued the holistic view for informing supportive care decisions. However, photo submission required substantial assistance for most participants, hence a significant barrier to overcome for implementation. Other barriers included digital literacy and delays in completion, which averaged 2.5 weeks.
Discussion: The eRFA-Photo-TiM approach was feasible and acceptable in a real-world cancer care in a regional cancer centre and may support more person-centred care decision making. Further research should evaluate effect on cancer care outcomes and sustainable implementation.
Smith R, Merlo G, Ezure Y, Love A, Lock C, Broadbent A, et al.
Objectives: Quality palliative and end-of-life care is required to meet the growing need in aged care. The aim of the Specialist Palliative Care in Aged Care (SPACE) service was to enhance equitable access to specialist palliative and end-of-life care for residential aged care residents in Queensland, Australia.
Methods: Local SPACE teams were established in each of 15 adult health services in Queensland. These teams provided services into residential aged care facilities in alignment with the statewide service principles of: (1) comprehensive resident-focused care; (2) streamlined service; and (3) capacity building. The SPACE teams provided advice for managing complex care and built generalist capability through education, training, mentoring and support for care planning. The effectiveness of SPACE was assessed through a repeated cross-sectional design. Data, including postdeath questionnaires, staff knowledge and confidence, organisational change, and resident and family experience measures, were collected in 6-month intervals.
Results: There were significant differences in the response distribution for place of death and for advance care planning across collection periods. Staff knowledge and confidence improved significantly in all areas assessed. There was also a significant change in the proportion of providers who improved palliative care policies, procedures or guidelines. Staff and resident stories attributed avoidance of unnecessary hospital admissions, improved quality of end-of-life care aligned with preferences, and improved coordination and continuity of care to SPACE's involvement.
Conclusions: The SPACE service demonstrated that a principle-based, adaptable model for accessing specialist palliative care can improve staff capability and improve end-of-life outcomes in residential aged care.
Clapham S, Ayalew AA, Redwood L, Yates P, Auret K, Clark K, et al.
Background: Understanding how symptom outcomes vary by care setting helps optimize care.
Aim: To compare trajectories of severe symptom distress in the final week of life across community and hospital settings.
Design: This retrospective consecutive cohort study used point-of-care data from the Australian Palliative Care Outcomes Collaboration, which includes the Symptom Assessment Scale and Palliative Care Problem Severity Score. Mixed-effects logistic regression models were adjusted for clinical, demographic and temporal factors.
Settings/ participants: Australian palliative care services (n = 165) contributed data for people who died between July 1, 2019, and June 30, 2024.
Results: Of 141,691 patients,73.6% were inpatients; 61.0% had a cancer diagnosis. Severe symptom prevalence was generally low (<5%). After adjusting important factors, inpatients had higher relative odds of severe pain-related (aOR: 1.20, 95% CI: 1.10, 1.30) and breathing-related distress (aOR: 1.55, 95% CI: 1.40, 1.70) compared with community patients; the corresponding absolute risk differences (ARDs) were minimal (pain: +0.36 percentage points; breathing: +0.79 percentage points). Conversely, inpatients had lower relative odds of severe fatigue (aOR: 0.86, 95% CI: 0.79, 0.94) and insomnia (aOR: 0.74, 95% CI: 0.66, 0.84), with small ARDs (fatigue: -0.32; insomnia: -0.26). Over time, severe breathing-related distress increased significantly as death approached, while pain-related distress increased slightly. Inpatients were also less likely to experience family/carer issues (aOR: 0.78, 95% CI: 0.72-0.84), or other symptoms (aOR: 0.57, 95% CI: 0.53-0.61), with small ARDs (family/carer: -0.56; other symptoms: -0.26).
Conclusions: While some relative differences were noted between settings, absolute differences were minimal, suggesting clinically comparable outcomes. These national data show that severity of symptoms in the two care settings are similar, reassuring patients, families, and health care professionals.
Grose D, Corbett C, Walker A, Lim WK, Smallwood N, Zentner D.
Aim: More older adults are living with an implantable cardioverter defibrillator (ICD). Deactivation rates for those approaching end-of-life are low, risking undue distress and an undignified death. This scoping review aimed to determine the availability and content of hospital guidance documents regarding ICD deactivation towards end-of-life.
Method: Guidelines' databases from two Australian states (Victoria and South Australia) were systematically searched between September 2022 to February 2023, to identify all documents that specified guidance for ICD deactivation at end-of-life. Relevant documents were analysed using a pre-specified data extraction tool.
Results: Following screening of 59,662 documents from 94 health services providing acute, aged or palliative care, 11 were included. Most were from public (10, 91%), metropolitan (eight, 73%) health services. Guidance on timing of ICD deactivation discussions was limited; only two (18%) documents advised discussion at time of insertion, one (9%) at generator change and six (55%) during advance care planning discussions. Recommended criteria for ICD deactivation varied: people with a terminal illness (two, 18%), with an active do not resuscitate order (five, 45%), receiving end-of-life care (11, 100%), or at the person's request (seven, 64%). Nine (82%) recommended consent dialogue that deactivation does not cause/hasten death (eight, 73%) or deactivate pacing (eight, 73%), aims to promote a peaceful death (eight, 73%) and that reactivation is possible (eight, 73%).
Conclusions: There is a paucity of local health service guidance to support clinicians navigating ICD deactivation at end-of-life.
Last updated 30 April 2024